By Beverly Mademba
Many cycles (pun intended) have passed since we celebrated the first Menstrual Hygiene Day in 2014, and since stakeholders started advocating for a stand-alone Menstrual Hygiene Management (MHM) policy for Kenya in 2015 under the leadership of the Ministry of Health.
As we start counting a new cycle whose first day was marked by the launch of Kenya’s Menstrual Hygiene Management (MHM) Policy 2019 – 2030[1] and an MHM Strategy 2019 – 2024[2]; I, for one, cannot hold the flow. I am excited!
Yes, a policy document does not magically change the situation, making it that all menstruators have access (economically and physically) and are using safe menstrual products of their choice and that they can change these in privacy and as often as necessary through ought their lives. Or that they have soap and water to wash their bodies as required, and have access to facilities to dispose of used menstrual management materials. Or that they have accurate facts on their menstrual health and can access menstrual health or reproductive health care services. Or that suddenly, all harmful societal beliefs, taboos and myths surrounding menstruation are washed away or that the needs of menstruators living with disabilities are addressed. Not at all.
So what can a menstrual hygiene management policy and strategy do for menstruators and menstrual hygiene and health practitioners?
It is the starting point for the institutionalisation of the issue, so that menstrual hygiene and health are not a fad. Institutionalisation means making it systemic. It means the allocation of resources, provision of standards, guidelines, protocols and indicators that can be monitored and through which duty bearers can be held accountable, becomes possible. The MHM policy is akin to the promise of relief that dysmenorrhea-prone menstruators anticipate with the administration of pain medication. The ultimate relief, however, will require a lot more work.
Even then, was it really necessary to launch this policy amidst the global COVID-19 pandemic?
Absolutely. You see, periods do not stop for pandemics. So how can we? If anything, the pandemic has highlighted and in many instances, further exacerbated the menstruation-related challenges that menstruators face around the world[3]. This includes disrupted access to information about menstruation; persisting period stigma and taboos; disrupted access to products; lack of access to WASH infrastructure, among other factors that make for period poverty. This is even more critical for persons living with disabilities or people additionally disadvantaged by other factors such as poverty. All this is while not considering the challenges that female frontline health workers are facing during their periods as they respond to the COVID-19 pandemic. Consider for instance, that since there are protocols to be followed while donning and doffing the personal protective suit, female nurses and doctors may be limited in how often they can take breaks to change their menstrual products.
What else has been happening in this crimson tide that is menstrual health and hygiene?
This needs more discussion.
There is a growing prioritisation, in part, because of the avid championing for menstruation. Champions for menstrual hygiene continue to grow in number and profile – from the County First Ladies’ Association to public health practitioners at the Ministry of Health taking charge as menstrual health champions. They rally the health fraternity and her affiliates, to invest in research for a better understanding of this phenomenon and factors thereof and for efforts to design and deliver effective menstrual health programming at scale. The fraternity of menstrual health and hygiene practitioners are convened through the Ministry of Health’s Hygiene Promotion Technical Working Group. Through this, joint advocacy, planning and learning happen. MHM is also included in other related policies such as the National Environmental Sanitation and Hygiene Policy[4]; the school health policy to support also the implementation of the amended Basic Education Act[5], which made explicit provisions for menstruation in Kenya.
What’s more, the body of knowledge on menstrual health and hygiene is growing from research being conducted throughout the country. There are startling findings, including transactional sex, in exchange for menstrual products. To strengthen research further is the recent development of Menstrual Practice Needs Scale MPNS-36[6], a validated tool to create better evidence of unmet menstrual needs and useful to evaluate menstrual health programming. A second study commissioned by the Bill & Melinda Gates Foundation Opportunity to Address Menstrual Health and Gender Equity[7]’ provides an assessment of the menstrual health sector. It identifies opportunities for the field to improve girls’ dignity and empowerment. This rendition of menstrual health happenings is incomplete without mention of the implementation of menstrual hygiene and health interventions by a variety of stakeholders in the country; from the integration of MHM in rural sanitation programming done by the Global Sanitation Funded (GSF) supported Kenya Sanitation and Hygiene Improvement Programme (K-SHIP), to the integration of MHM in the COVID-19 response by Amref Health Africa, the Kenya Red Cross Society (KRCS) and UNICEF to name but a few. All this is while yet mentioning the growing innovations on menstrual products, and the development of technical guidelines for MHM programming by WSSCC, UNICEF and the development of a toolkit to integrate MHM in humanitarian response done by IRC in 2017.
Additionally, is the growing number of coalitions on menstrual health, such as the African Coalition for Menstrual Health Management[8], the Menstrual Hygiene Alliance[9] and the Global Menstrual Health and Hygiene Collective, to name but a few, through which practitioners can shape the regional and global menstrual health and hygiene agenda.
What can you do for this cause?
We are all gearing up for the dissemination, implementation and monitoring of the impact of the MHM policy. As you join in or as you continue with the service you have been doing on menstrual hygiene and health, do apply a holistic approach. The starting point must be breaking the silence; by talking openly about menstruation with both men and women, by providing accurate information on menstruation and by addressing the myths and taboos. This is the first step, a required precursor to safe and hygienic management and disposal, where menstrual material and associated amenities come in. While at it, there is a need to continue with advocacy as there are many knots in this period yarn, which are yet to be untangled, including a system for safe and hygienic disposal of used menstrual material and standards for reusable menstrual products. Menstrual hygiene and health require inputs from all, state and non-state actors, the private sector and academia and across all sectors. In all these, priority must be on those who are often left out, such as persons with disabilities and their caregivers and on menstruators disadvantaged by other factors such as poverty.
We must not, and we cannot stop until no one is left behind and until all menstruators can menstruate safely and with dignity.
[1] Accessible at https://www.health.go.ke/wp-content/uploads/2020/05/MHM-Policy-11-May-2020.pdf
[2] Accessible at https://www.health.go.ke/wp-content/uploads/2020/05/MHM-Strategy-11-May-2020.pdf
[3] More information accessible at https://www.unicef.org/media/68446/file/Mitigating-the-impacts-of-COVID19-on-menstrual-health-and-hygiene-Brief.pdf AND https://menstrualhygieneday.org/wp-content/uploads/2020/05/mhday2020-covid19-and-periods-logo.pdf
[4] Accessible at http://guidelines.health.go.ke/#/category/16/53/meta
[5] Accessible at http://kenyalaw.org/kl/fileadmin/pdfdownloads/AmendmentActs/2017/BasicEducation_Amendment_Act_17of2017.pdf
[6] Accessible at https://www.menstrualpracticemeasures.org/
[7] More information accessible at https://www.fsg.org/publications/opportunity-address-menstrual-health-and-gender-equity#download-area
[8] Accessible at https://www.facebook.com/AfriCoMHM/
[9] Accessible at http://www.mh-alliance.net/